Urethral Stricture Symptoms
- Blood in the urine
- Difficulty urinating
- Frequent urination
- Painful urination
- Spraying of the urinary stream
- Discharge from the urethra
Diagnosis includes a detailed history and physical including onset of symptoms and severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including:
- Post-void residual volume: determining how well you empty your bladder
- Urinary flow rate: strength of urinary stream retrograde urethrogram: X-ray performed while instilling dye into urethra
- Cystoscopy: looking into the urethra and bladder with a small telescope
Incontinence Treatments:
Various treatment options exist, each with their own advantages and disadvantages.
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Urethral Dilation
Gently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.
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Endoscopic Incision
The stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.
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Open Urethroplasty
Removing the diseased segment and replacing with healthy tissue. The technique used depends on location and length of the stricture, as well as surgeon experience. For longer strictures, a tissue graft is usually needed to bridge the gap. The tissue used for grafting can include local penile skin or even buccal mucosa from inside the cheek. Success rates are typically very good with low recurrence rates, especially with surgeons with experience in performing these procedures.
Leakage of Urine with Sexual Intimacy
Men who have undergone radical prostatectomy may have urinary leakage not only with normal day-to-day activities, but may have leakage of urine with sexual activity. Climacturia (leakage of urine with orgasm) and leakage with sexual arousal are not uncommon after the removal of the prostate gland. Men who leak urine with sex are very frustrated. This area is one in which Dr Christine has the largest series of patients successfully treated using an AdVance XP male sling. The cure rate has been truly amazing with over 80% of men with sexual activity induced urinary incontinence completely resolving after sling placement. A minor surgery that takes less than an hour to perform, as an outpatient, can end this embarrassing problem.
Another option to treat urinary leakage with intimacy in men who have had a radical prostatectomy can be a Mini-jupette procedure. This is a different type of sling, placed at the time of a penile implant surgery; so, for men who have ED and climacturia, one surgery can be the road to a return a satisfying life.